A system of surgery . theglenoid ligament, between the two headsof the flexor brevis pollicis, containingthe sesamoid bones which embrace itsneck (Figs. 399, 400). The prominenceof the head of the metacarpal bone maybe felt anteriorly, and the base of thedisplaced phalanx dorsally. The phalanxis flexed dorsally, forming an obtuse anglewith the metacarpal bone The obstaclesto reduction are said to be the constric-tion of the neck of the metacarpal boneby the short flexor tendons ; but I aminclined to believe that torn and twistedportions of the glenoid ligament inter-vening, and being wrapped r
A system of surgery . theglenoid ligament, between the two headsof the flexor brevis pollicis, containingthe sesamoid bones which embrace itsneck (Figs. 399, 400). The prominenceof the head of the metacarpal bone maybe felt anteriorly, and the base of thedisplaced phalanx dorsally. The phalanxis flexed dorsally, forming an obtuse anglewith the metacarpal bone The obstaclesto reduction are said to be the constric-tion of the neck of the metacarpal boneby the short flexor tendons ; but I aminclined to believe that torn and twistedportions of the glenoid ligament inter-vening, and being wrapped round theneck of the bone, are potent causes of theundoubted difficulty found in the treat-ment of this displacement. To relax the ligaments and the shortflexor tendons as much as possible, themetacarpal bone should be strongly ad-ducted, and the base of the phalanx pushed forwards with thethumb of the hand that grasps the metacarpal region. The displacedphalanx should be strongly drawn at first in the direction of the. Fig. 400.—Appearance in DorsalDislocation of the first Phalanxof the Thumb. 992 DISLOCATIONS. displacement— in dorsal flexion—and as the surfaces disengage,it should be brought towards the palm, still keeping up adduction of the metacarpal bone, and traction in dorsal flexionthe opening between the heads of the short flexor and in the apo-neurotic structures gapes, and on extending, the metacarpal boneslips backwards and the base of the phalanx forwards, thuseffecting reduction. The common error made in this manipula-tion is to exercise direct extension, before adducting and makingtraction on the phalanx in dorsal flexion. Should reduction proveimpossible, open arthrotomy should be at once performed by a free
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